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Constructive dissatisfaction

As we walked down the hall together, the chief nurse executive at the hospital I was visiting commented that the nurses had been complaining. In fact, they had a long list of complaints, and they were right; a lot of processes weren’t working well and were creating problems for them. Understanding how she felt, I shared that I’d been thinking about “constructive dissatisfaction.” I believe it’s okay to be dissatisfied if we also commit to improvement. This is how we build a bridge from where we are to where we want to be. Isn’t this the heart of lean?
We didn’t have time to discuss further...

The New Johari Window—a tool for understanding what we know and practice, and what we don’t!

When I first saw the New Johari Window (shown above) I thought, “Oh, that’s busy. I wonder what it all means?” Learning what it meant made a big difference in my work.
The source of the New Johari Window is CEDAC: A Tool for Continuous Improvement,[1] where Ryuji Fukuda shares it as a tool for identifying causes of process failures. His examples include missed communication, lack of skills, and lack of awareness of what each person knows. The original Johari Window is a visual model of interpersonal communication that can be used for improving communication, created by Joseph Luft and...

Celebrating the vital role of nurses in healthcare

National Nurses Week is a time to celebrate the vital role of nurses in healthcare. The week-long recognition begins each year on May 6 and ends on May 12, Florence Nightingale’s birthday.
First celebrated in 1954, the 100th anniversary of Nightingale’s pioneering nursing approach during the Crimean War, official recognition began in 1982 when President Ronald Reagan signed the proclamation declaring May 6 as National Nurses Day. In 1994, the American Nursing Association (ANA) permanently designated National Nurses Week May 6-12. This year’s theme, “Nurses: Inspire, Innovate,...

Waste

In the lean philosophy, any work that doesn’t add value is waste. Waste should be eliminated. That’s not a value judgment on the people doing the work. People shouldn’t have to endure wastes like awkward movements of bending and twisting, looking for supplies or information, clicking too many times when using software, or rushing to prepare a report with bad information that will have to be reworked later. People feel these wastes, and they are ready for better. In my opinion, waste contributes to burnout. People don’t mind working, but it bothers them when their effort is wasted.
Value...

National Doctors’ Day

It seems like most every day is a “National Day” of something. In fact, according to www.nationaldaycalendar.com, National Doctor’s Day is also National Pencil Day, National Take a Walk in a Park Day, and National Turkey Neck Soup Day. I do enjoy walks in the park and the simple pleasures of using a pencil (love that eraser!), though I am fairly sure I will never have turkey neck soup. Doctors, however, have my undying respect and fondness.
Physicians have gone through so much just to be able to practice. One has to be hard-working and excel academically to make it into medical school (a...

Value

In lean (Toyota Production System), value is defined by the customer. To be considered value adding, an activity must meet a high standard: Does it change the form, fit, or function toward customer needs or wants, and is it done correctly the first time (rework is never value adding)? In healthcare, we’ve also added “feeling,” as a patient moves from concerned to reassured. An equivalent question is: Would the customer pay for this activity? 1
Here’s a customer’s perspective on value: When my three-year old nephew comes to visit, he wants me to make my chocolate chip cookies – warm and...

Respect

Working with an improvement team that displayed deep cultural commitment to respect got me curious about “respect.” What is a culture of respect? I saw the usual habits of respect: leave titles at the door, no interrupting, no blaming. This team had something more. Here are a few examples:
When a colleague shared how she’d made a mistake, the team asked her to walk through the steps of what happened. When she blamed herself, they redirected the conversation to the process by asking questions about the process steps. When she finished, they thanked her and explained that because she had...

Beyond workplace heroics

The world appreciates heroes--they achieve the extraordinary! Workplace examples include the programmer who comes in at 8:00 am after working until 4:00 am installing the latest software version; the nurse who pulls a double shift; the lab scientist who repairs machinery on the weekend, and the administrator who makes the eighth round of revisions to the board report.
These are good people working hard within broken systems. We can do better. We need to move beyond dependence on heroics. We can do better, such as:
Coordinating the schedule so that the software tech can have...

Reflections on MLK and his Letter from a Birmingham Jail

With great wisdom well beyond his 34 years, Martin Luther King Jr. penned his famous Letter from a Birmingham Jail in response to criticisms from 8 white clergy members in April 1963. A couple months later the letter was published and I encourage you all to read it or any other works of MLK as we reflect on his life and legacy this day.
MLK wrote, “We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly affects all in-directly,” and it is a poignant reminder that our words and deeds have impact on others far more...

Wait…don’t tell me

This crossing sign visualizes the concept of pausing before moving forward together, just like the request to “wait…don’t tell me.” I experienced this pausing before moving forward when helping a 9-year old with her third grade reading homework. She was struggling and asked me to tell her the words she didn’t know. After doing that a few times, I realized that when I gave her the answer, she didn’t recognize the word the next time she saw it. So, I slowed down. When she didn’t know a word, we paused and she sounded it out – she began to recognize these words the next time they appeared....